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An Engineering Approach to Translational Medicine

Physician-scientists may benefit from an approach that emphasizes solving problems over generating hypotheses

Michael Liebman

Heterogeneity of Breast Disease

Breast tumors are usually composed of more than one type of cancer. This is a problem when the cancers do not all respond to the same treatment. Although scientists know about this phenomenon, it has been difficult to quantify because pathologists use differing diagnostic criteria. In the CBCP, we have the advantage of having a single pathologist review all patient samples. We think it likely that when a tumor biopsy has a specific combination of subdiagnoses, it is more accurate to describe the tumor in terms of its heterogeneity rather than noting only the severest cancer (the current convention). The CBCP categorization scheme contains 135 potential subdiagnoses for tissue sections. Among 891 patient samples, we have observed 75 of these. Although most combinations are rare or nonexistent, others are extremely common: We found two cancers that had a 92 percent likelihood of showing up paired rather than alone. This finding suggests that we may need to review the tumor-classification system to reflect this heterogeneity, thereby refining our evaluations of tumor stage and grade and improving treatments for patients.

An engineering perspective analyzes breast cancer by viewing the whole patient and applying customized treatments that reflect each person's unique confluence of biology and experience. We hope that this practice reinvigorates the study of breast cancer and other diseases to enhance patient care—the ultimate goal of translational medicine. To my basic-science colleagues, I say that our engineering counterparts have been looking at the world through somewhat different glasses, and perhaps it is time to share the view.

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